Occlusal index-assisted restitution of esthetic and functional anatomy in direct tooth-colored restorations

Restitution of the complex central sulcular portion of teeth is extremely difficult when direct tooth-colored restorative materials are used, because sculpturing of the solid polymerized mass is accomplished mechanically with burs. When the initial carious lesion presents within a shell of undermined yet intact enamel, the preoperative occlusal morphology provides an ideal index of the esthetic and functional anatomy. The preoperative occlusal morphology is recorded in a transparent registration material, and then the registration is used as an index to reproduce the preoperative occlusal morphology in the final incremental restorative layer. Photopolymerization of the restoration is initiated through the translucent index and completed with surface approximation of the light source once the index has been removed.